ABSTRACT
CASE PRESENTATION: A 49-year-old woman with a medical history of epilepsy presented to the ED 1 h after a single, 15-min, witnessed, tonic-clonic seizure. Over the preceding 6 months, she had experienced five similar seizures of shorter duration. There were no recent changes to her phenytoin dose nor had she started any new medications. The patient had traveled to Jamaica 3 weeks before presentation, where she smoked marijuana once but otherwise had not used illicit substances nor had she used tobacco or alcohol. She states she felt well during and after the trip until this presentation. While being evaluated by the neurology service, the patient complained of sudden-onset chest pain and cough with associated hypoxemia. She denied changes in her sleep habits, she had not experienced any fevers, and she had no changes in her exercise tolerance. The patient was admitted to the general medicine floor for further workup.
Subject(s)
Chest Pain/etiology , Cough/etiology , Hemoptysis/ethnology , Hypoxia/etiology , Pulmonary Alveoli/blood supply , Pulmonary Edema/complications , Seizures/complications , Biopsy , Chest Pain/diagnosis , Cough/diagnosis , Diagnosis, Differential , Female , Hemoptysis/diagnosis , Humans , Hypoxia/diagnosis , Middle Aged , Pulmonary Edema/diagnosis , Tomography, X-Ray ComputedSubject(s)
Echinococcosis, Pulmonary/complications , Echinococcus granulosus/immunology , Hemoptysis/etiology , Travel , Animals , Antibodies, Helminth/analysis , Bronchoscopy , Diagnosis, Differential , Echinococcosis, Pulmonary/diagnosis , Echinococcosis, Pulmonary/ethnology , Echinococcus granulosus/isolation & purification , Enzyme-Linked Immunosorbent Assay , Female , Follow-Up Studies , Hemoptysis/diagnosis , Hemoptysis/ethnology , Humans , Philippines/ethnology , Radiography, Thoracic , Tomography, X-Ray Computed , United Kingdom/epidemiology , Young AdultABSTRACT
SETTING: Tertiary referral centres. OBJECTIVE: To provide comprehensive updates on the aetiologies, angiographic findings and outcomes of bronchial artery embolisation (BAE) for life-threatening haemoptysis in Hong Kong. DESIGN: Retrospective review of clinical records of consecutive patients presenting with life-threatening haemoptysis from 2000 to 2006. RESULTS: There were 3006 admissions due to haemoptysis involving 2260 patients during the study period; of these, 251 patients had life-threatening haemoptysis. Pulmonary tuberculosis (PTB) (active or inactive) and bronchiectasis were the main underlying causes. BAE was attempted in 167 patients. There was a high prevalence of bilateral bronchial arterial abnormalities (31.7%), presence of abnormal non-bronchial arteries (41.3%) and presence of broncho-pulmonary shunt (38.9%). BAE had a high immediate success rate of 95.7%, with a 5-year recurrence rate of 45.0%. Recurrent life-threatening haemoptysis was independently associated with past history of haemoptysis (P = 0.024), presence of broncho-pulmonary shunt (P = 0.013), and incomplete embolisation (P = 0.002). Complications were uncommon (<5%) and self-limiting. CONCLUSIONS: In Hong Kong, about one tenth of admissions due to haemoptysis were life-threatening. PTB and bronchiectasis were the major causes. Complications due to BAE were uncommon and self-limiting, with super-selective catheters.
Subject(s)
Bronchial Arteries/abnormalities , Bronchiectasis/complications , Embolization, Therapeutic , Hemoptysis , Hemostatic Techniques , Tuberculosis, Pulmonary/complications , Aged , Aged, 80 and over , Asian People , Bronchial Arteries/diagnostic imaging , Bronchiectasis/diagnostic imaging , Bronchiectasis/ethnology , Embolization, Therapeutic/adverse effects , Female , Hemoptysis/diagnostic imaging , Hemoptysis/ethnology , Hemoptysis/etiology , Hemoptysis/mortality , Hemoptysis/therapy , Hemostatic Techniques/adverse effects , Hong Kong/epidemiology , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Proportional Hazards Models , Radiography , Recurrence , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Tuberculosis, Pulmonary/diagnostic imaging , Tuberculosis, Pulmonary/ethnologyABSTRACT
A 28-year-old African American male, originally from West Africa, presented with complaints of cough and hemoptysis. This case follows the patient through transfer to Walter Reed Army Medical Center and outpatient follow-up. Exploring this case illustrates how an Army physician may approach a soldier with hemoptysis. Additionally, this case demonstrates the management and treatment of his condition.
